Form A-62 at a glance
What it is: Form A-62 is the application for a special permit to operate a motor vehicle to and from work.
Who signs: Fill in Printed Name of Applicant and Date Signed, and sign on the Signature of Applicant line. The supervisor signs on the Signature of Supervisor line.
What to bring and attach to Form A-62
A check or money order payable to DMV must accompany each request for a permit.
If self-employed, include business name and legal proof of self-employment.
A filled-in Form A-62 example: a work permit for a daily commute
How to fill out Form A-62, box by box
Your name, birth date, license and sex
Enter the Name of Applicant (Last, First, Middle), Date of Birth, Operator License Number/State and Sex.
Mailing address and residence address
Enter the Mailing Address (Number and Street) (City or Town) (State) (Zip Code) and, if different, the Residence Address (Number and Street) (City or Town) (State) (Zip Code).
Your employer and your telephone number
Enter the Name of Employer.
Enter the Address of Employer (Number and Street) (City or Town) (State) (Zip Code).
Enter the Occupation and the Home Telephone Number.
Days and hours of employment
To be issued a work permit, your schedule must be clearly identified, and may not exceed a continuous 12-hour period per day. If you have more than one place of employment, each employer must complete a separate application.
Under Days and Hours of Employment, specify A.M. or P.M. for MON., TUE., WED., THU., FRI., SAT. and SUN.
Distance, commuting time and public transportation
Enter the distance and the commuting time from your residence to your place of employment.
Mark YES or NO: Is public transportation available from your residence to your place of employment?
Hardship and other transportation
Enter the significant hardship(s) you will suffer without a Special Operator's Permit.
Enter the efforts you have made to obtain other transportation.
The supervisor
Inability to confirm your employment may result in denial of your Special Operator's Permit.
The supervisor fills in Printed Name of Supervisor, Printed Job Title of Supervisor and Work Telephone, and signs on the Signature of Supervisor line.
The oath
Under OATH, you swear or affirm under penalty of false statement in accordance with Connecticut General Statute 53a-157, and subject to penalties for perjury for a deliberate false statement, that the information in this application and any attachment hereto is true and correct.
More rules for Form A-62
Your official driving record will be reviewed as part of this application.
Operation of motor vehicles requiring a CDL or used for Public Passenger Transportation is PROHIBITED under the Special Permit Program.
Please print or type.
Your operator's license is under suspension. If you operate any vehicle outside of the authorized hours, you may be subject to arrest.
If your operator's license is suspended for another reason while you are in possession of this permit, the permit is revoked, and if you thereafter operate a motor vehicle you will be subject to double the penalties imposed by law.
If you alter or make improper use of the permit, you will be subject to criminal penalties.
Common questions about Form A-62
Where do I file it?
The form prints the State of Connecticut Department of Motor Vehicles Driver Services Division, 60 State Street, Wethersfield, CT 06161-2530.
Are there fees?
A $100.00 non-refundable application fee in the form of a check or money order payable to DMV must accompany each request for a permit. (checked November 2, 2026)
Is there a penalty?
If you operate a motor vehicle for a purpose not authorized by law, a police officer may make a report to the Commissioner of Motor Vehicles and you will be subject to a civil penalty of up to $500. (checked November 2, 2026)
Sources
[1] Form A-62 (REV. 4-2010), Application for Special Permit to Operate a Motor Vehicle To and From Work, State of Connecticut Department of Motor Vehicles (the Official source link on this page).
